=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649137274
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAMELA GONZALEZ MARQUEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2026
-----------------------------------------------------
Last Update Date | 01/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 303 COMMERCE CENTER DR
-----------------------------------------------------
City | SAINT CLOUD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34769-1549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-450-5985
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8017 NEW RIVER DR APT 17205
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32821-5493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-835-6169
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 4400
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------